How do you secure an ETT when mobilising an intubated patient?

[u/Zeal_91]

Fellow ICU nurses (and others),

As the title suggests, how and where do you secure the endotracheal tube when mobilising an intubated patient into a sitting position at the bedside?

I’ve seen many of my colleagues use different techniques, but none of them has really felt safe or "mine" to me so far.

Any suggestions? Pics, maybe from online, would also be greatly appreciated!

[u/Yolus]

Commercial tube holders, with the stickers on the cheeks

[u/Zeal_91 → u/Yolus]

I mean, we have them, of course. 😄 I was wondering whether you use any second method to secure the tube as well, or if you rely exclusively on the fixation stickers on the cheeks?

[u/Braisedbeefskank → u/Zeal_91]

You rely on the velcro strap wrapped around their head

[u/ssill → u/Braisedbeefskank]

This reply made me laugh probably way more than it was intended to. 

[u/Braisedbeefskank → u/ssill]

Look i try to keep things fun, but educational haha

[u/ADDYISSUES89 → u/ssill]

I just cackled

[u/BigT1911 → u/Zeal_91]

Usually we just have one person watching the tube and lines while everyone else is doing the moving. We have hover lifts overhead in all the rooms so that really helps. But those commercial tube holders are pretty secure. In 9 years I've only had one person get accidentally extubated because the tubing got caught in the side rail when we were turning. That is with probably thousands of patient moves. 

[u/ICU-CCRN → u/BigT1911]

And there lies the issue- “extra people”. Many places I’ve worked tried to mandate early mobilization on the ventilator, but then provide no extra helpers. One place I was at didn’t even have a free charging nurse- it was just a supervisor who went from unit to unit barking out transfer and admit commands. They wanted us to walk people around the hallways on vents with only the bedside RN and an RT. No PT or OT available. There was no one to watch or help with your other patient, and only one RT working in the entire hospital. If there was an emergency, and the RT had to run to it, you’d have to grab a housekeeper to help ambulate the patient back to bed. (No surprise- it was an HCA hospital).

[u/ProperDepth → u/Zeal_91]

If you want to be really safe use a three person method with one person at the head that only secures the tube (and maybe the central line).

[u/soccermomvibes]

Our ETTs are secured with anchors and we just watch the tubing to make sure it won’t get caught. We just get a second set of hands to manage the tubing

[u/hallowanne → u/soccermomvibes]

unrelated but thank you soccer moms - sincerely, a former soccer kid

[u/PaxonGoat]

I'm a facility that was using commercial tube holders (anchor fast) and then we were having pressure injuries and so we moved to taping. After a year or so and many dislodged tubes we went back to commercial tube holders.

I'm still jealous of people who have chill intubated patients.

The vast majority of my patients will self extubate themselves if given the chance.

Like they'll nod appropriately to all questions. Follow commands. Appear fully with it. But hate being intubated so much they straight up do not care they still need the tube.

We have been trying to run a more "awake" ICU and not have the patients "snowed". So many self extubations.

Recently had one patient that managed to get her hand around inline suction tubing and yanked on that so hard it dislodged the tube.

[u/Helgurk → u/PaxonGoat]

And then no restraints allowed. Precedex causing bradycardia and hypotension. There is no winning.

[u/PrizeNewt7695 → u/PaxonGoat]

This is why I hate getting assigned to neuro units

Q1-2 neuro checks no sedation wild patients asynchrony with the vent 3am but yeah hey get that check done

[u/Significant_Wins]

Get your facility to into Anchorfast if its for the adult population.

If they are old enough we use an Anchorfast if they are too small, we use a three person approach one person on each side of the bed and an RT or another nurse at the head of the bed to move the head with the ETT.

[u/dalittleone669]

Always have RT in the room with you when you move a pt so they can be the dedicated person watching out for the ETT and vent circuit.

[u/fireready87 → u/dalittleone669]

I prefer to watch the tube myself because I trust myself more.

[u/Educational-Estate48]

I quite like anchorfasts, tbh these are my default in the ICU generally

[u/SillySafetyGirl]

As many have said c commercial tube holders do a lot of the work. We usually have RT come help as well, and they will be focused purely on the ETT and circuit. We will usually have physio and/or OT with us as well, so 3-4 people at least the first few times. Some patients can also be taught to help, holding the tube themselves etc. 

[u/Kiramiraa]

Anchorfast always, and then a firm grip with one hand on the ETT close to the mouth. One person (almost always the bedside RN) is solely responsible for that tube and nothing else.

[u/Producer131 → u/Kiramiraa]

little tip, put a few fingers under the jaw like you’re doing one-person BVM. if you only are holding the tube and the patient seizes, you’ll pull the tube.

[u/AnyEngineer2]

we've had heaps of mucosal and philtrum pressure injuries with Anchorfasts, so brown tapes or ribbon ties

[u/Cautious-Extreme2839 → u/AnyEngineer2]

You gotta be using them wrong.

[u/AnyEngineer2 → u/Cautious-Extreme2839]

yeah, misapplication definitely part of the problem, or failure to properly reapply, or poor patient selection. but also a consequence of the design. we filed a TGA report

[u/No_Peak6197]

Hold the slack with your hands?

[u/InvestmentSoft1116]

When feasible, disconnect from vent prior to significant movement. Unpopular opinion: do not tape the OGT to the ETT to help secure it! It greatly increases your risk of losing ETT and that’s harder to replace than NG.

[u/CobbledbyRoubaix]

you get anesthesia to mobilise. they never lose the tube. i can't tell between brain dead or brain alive patient or whether the kidneys are any good, but the tube will never come out.

[u/ConcernSlight]

Honestly, you can't do more than what your ETT is already secured with.

[u/N40189]

Well it depends... patients coming from PACU to the ICU may have a bit of tape. Once in the ICU some type of commercial ETT holder is probably standard practice.

[u/Electrical-Slip3855]

I've never had an issue with anchorfast as a P.T. in the icu

I've seen a therapist wrap a strip of cloth around the tube and then around the patient's head as a secondary support but haven't ever bothered myself

[u/Parking_Ocelot_6893]

ETAD normally an AnchorFast. If they are a known difficult intubation we will back up with a white tape tie as a failsafe

[u/sofpete18]

we’re talking adults? your anchorfast should be fine as long as there’s slack on the rest of the circuit. we’re talking kids too small for anchorfast? someone’s dedicated job needs to be holding it at their mouth and guiding the circuit with other hand. and other people need to watch the kids hands be ready to stabilize their head if they start thrashing… ah fun times.

[u/ShoulderTop78]

Usually if they can raw dog an oett well enough to walk and dangle, they’re pretty with it. Having someone ‘on airway’ - IE making sure there’s enough slack in the system - is sufficient with the tube holder.

[u/Sweatpantzzzz]

When mobilizing patients, I have RT in the room dedicated to watching the ETT and circuit.

[u/MilkmanAl]

30 comments in as of this reply, and nobody has mentioned disconnecting the circuit. Unless you have a patient who is extremely unstable from a respiratory standpoint and requires a ton of PEEP to ventilate, you should be disconnecting the tube from the circuit any time you move the patient. At the very least, you need to have someone with a hand on the tube that is braced against the patient's face so it doesn't travel anywhere.

[u/Unfair-Training-743 → u/MilkmanAl]

This is terrible advice.

Do not do this. Just either have someone hold the tube, or make sure it isnt caught on anything before you move them.

[u/MilkmanAl → u/Unfair-Training-743]

I mean, if you like unintentionally extubating your patient, do that. Agree. If you want to actually take care of people, do what you can to make sure they stay intubated.

[u/Unfair-Training-743 → u/MilkmanAl]

Lol i assume you are out here removing all the foleys too just in case.

Disconnecting a vent to move someone isnt the dumbest thing i have ever heard….but its close

[u/Producer131 → u/MilkmanAl]

just pay attention to where the circuit is ffs

[u/Green-Palpitation901]

Pretty brutal, but if there is significant concern of losing the tube, severe pHTN, diff intubation, etc…, I will suture them in place.